You’re fit, but not invincible. Getting checked at 40

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It’s not cancer awareness month, Movember, or anything special to bring men’s health to the forefront of thought at this time. And that’s precisely the point. Cancer doesn’t wait or discriminate so now is as good of a time as any to talk about ‘The Big C’ that we’d all rather avoid.

Peter Bolton is that guy in the bunch who is always happy and positive, never shirks a turn on the front, and has no ego to speak of. It was three years ago where I noticed Peter’s good vibes missing in our morning bunch ride but never gave it a second thought. In the cycling community our friendships can sometimes span a mile wide, an inch deep and often six months can pass in a flash before we see someone again.

It was back in November when Peter was chosen as a prize winner for our Jaguar weekend “Why I ride” weekend away where entrants submitted their reasons for why they ride. Peter was the final winner and while I had nothing to do with picking Peter, the moment I saw his entry I knew he had to be on that trip.

It went like this:

Peter in hospital bed getting his first chemo treatment
Peter in hospital bed getting his first chemo treatment

“Why do I ride? I have ridden a bike for about 30 years so the answer to that question has changed. At first it was because my mates all rode bikes to get around as a teenager. Then it was to train for a triathlon. Riding a bike was fun. So then it was to train and race road races. This was it, racing a bike was great fun. You could inflict pain onto your friends when you were fit or suffer like a dog if you weren’t. Even have a win here and there if you were lucky. You had to get up early to train in the dark before work, but we all did it so that was ok. Racing gave you that nervous excited feeling that was good and bad. Balancing family, work and cycling sometimes meant that cycling took a back seat but never forgotten. Recently I was stuck in this hospital bed diagnosed with cancer. Cancer took away my cycling for about 6 months. But it wasn’t going to win that battle. From that bed I remember looking out the window one Saturday morning, it was sunny but still early. I could see guys riding down St Kilda road heading off on their rides. I was gutted. Now, a bit of cold, bit of rain, bit of wind, no drama it’s better than being in that bed. So now I ride again. I suppose the real reason why I ride a bike is because, I LOVE IT and I CAN!” – Peter”

To cap the weekend off I thanked everyone for coming and sharing their stories and unique perspectives. I used Peter’s example in my little thank you speech, but as I spoke and made eye contact with him I could see there was something wrong with my words.

On the drive home, Peter confided in me and said, ‘the cancer is back’.

Fit doesn’t always mean healthy

Ever since Peter returned to our morning bunch ride back in 2014 he had been asking everyone with his usual enthusiasm, “have you got your 40 year old health check yet mate?” It was his mission to use his cancer experience to spread this message. Peter hadn’t gotten his check-up at 40, and if he had, the doctors could have caught it much earlier.

Peter explained, “In my life I never look back with regrets at yesterday or through the years, but what should have happened in my life, when I got to 40, I should have started to think that just because I can ride for hours on end, I should have looked at my health more closely and not just my ‘cycling or fitness health’. I should have looked at the health that was going on inside my body and I should have done more to go to the doctor and get checked. Just so they have a history of what’s going on inside your body. If I had that history I would have gotten to 50 and they would have seen that something’s changing here and would have done a deeper look. And my life might be a little different right now and where I’m at with my cancer.”

When asked how he found out about his diagnosis, as with many of these stories it starts out as a mistake. Peter reminisces, “If I look back for the whole of 2013 I was getting a bit thinner, weaker and a bit tired. I didn’t realise all those things put together meant something. I ended up getting a fever that I got antibiotics for and the GP couldn’t work it out. Eventually I complained that I had a sore bum cheek and the doctor thought I had some sort of abscess and I went in to get it drained and to get a biopsy on it. They didn’t like the looks of the biopsy so they kept me in hospital for a couple weeks. Then then told me I’ve got rectal cancer. I was 51 at the time. ”

Only a few days earlier Peter was riding some of the tallest, most difficult mountains in Australia. He was fit as a fiddle and managed to ignore the symptoms.

“I think we put up with a lot of pain and suffering and we can mask a few things and put it down to training too much or having a tough ride,” he said. “You don’t want to face those things that can stop you from riding your bike. When they said I had cancer, all I remember is sitting in a hospital room with my wife, my mom and my son and this young doctor. I don’t even remember, but my wife told me that I went flying across the room swearing at this guy telling we gotta get started now, we gotta do this, we gotta do that…I turned into a robot just firing all this stuff at him.”

Bouncing back

Fortunately our cycling obsession can prepare us for bigger hurdles in life other than bike races.

“The doctors told me that you lose a third of your health when you go through chemotherapy,” Peter said. “Most people don’t die from cancer, they die from the complications and things they can’t cope with. The cancer keeps getting treated, but people often die from pneumonia or their immune system goes down and they catch something from that. But when you’re starting so fit and healthy and then you take a third off it, you’re still way ahead. It makes it so much easier to deal with the treatment. But I suppose we put in a lot of time towards our fitness and not everyone can afford that time.”

To get an understanding of what ‘health’ is in this context and what chemotherapy does to a patient, I asked Dr. Mark Haykowsky, Professor and Moritz Chair in Geriatrics, College of Nursing and Health Innovation, University of Texas at Arlington.

Dr Haykowsky explained “Peak oxygen uptake (VO2peak) is the gold standard measure of cardiorespiratory fitness. Peak VO2 in individuals diagnosed with colorectal cancer treated with chemotherapy has been shown to decline by 3.0 ml/kg/min.”

In other words, chemotherapy can decline the ‘health’ of a sedentary male equivalent to 8 years of ageing.

Dr. Haykowsky also explained how regular exercise can improve cancer patients health throughout their treatment.

He said, “Our research group has shown that regular exercise training can improve cancer survivors peak VO2 by 3.1 ml/kg/min and the magnitude of this improvement is related to the exercise workload. Specifically, we found that the threshold workload level required to obtain a clinically significant large improvement in peak VO2 was 600 intensity minutes (10 week program of 90 minutes of exercise training per week at 70% peak VO2).”

For those of you who are obsessed with your cycling, that sounds quite achievable with what you already do.

Peter remembers, “When the surgeon operated on my bum, he said that normally when they slice through that cheek it comes open like butter. But he said that it it took them 10 times the effort to do the surgery on my bum than it normally would because the muscles were so dense from all the bike riding. ‘Mine were nothing!’ I said. I could have brought in guys built like tractors for them to see!”

“The doctors told me that they’re not used to seeing people who want to get up out of the bed. They told me that they want me to exercise, and I told them that I’m walking the dog for 3 hours a day and riding for 2hrs a day. They said, ‘ah yeah…that’s more than enough. We were just hoping you could walk around the block”

Many stories don’t end well as Peter’s, and it’s far from over for him. The cancer is back, but true to form his optimism shines through.

“More good has come out of this experience than bad, personally for myself,” he explained. “I wouldn’t swap what I went through. My life is better now than it was before. the quality of time I now spend with my family, the stress of stuff doesn’t bother me so much more. I’m able to have conversations with young people at the hospital who are facing really big journeys ahead of them with cancer and I can tell them my story and they think ‘wow, you’re still riding your bike!”

If you’re reading this and are holding off on your 40 year old check up because you think you’re fit and healthy, we hope Peter’s story will prompt you to see your doctor so that you stay that way.

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